The Housing Challenges on Native American Reservations
Substandard housing contributes to the health inequities and medical challenges we face in caring for our American Indian patient population.
I took this photo back in May at sunrise on the Colville Reservation in Washington state on my way to work as the sun was hitting top of the Cascade summits over Omak, Washington. The town of 6000 sits on the Okanogan River which forms the western boundary of the Rez. The east bank of the Okanogan is tribal land and there are several low-income housing developments for tribal members in need on this side of the River.
Forty percent of homes on Native American reservations are considered substandard compared to 6% nationwide. Substandard housing has any condition which exists that it endangers the safety or welfare of the occupants- inadequate sanitation, lack of water/heat, inadequate ventilation, structural hazards, inadequate weatherproofing, fire hazards, or insect/vermin infestations.
Substandard housing contributes to the health inequities and medical challenges we face in the Indian Health Service and tribal health clinics in caring for our patient population.
Less than half of the homes on reservations are connected to sewer systems, sixteen percent lack indoor plumbing. In some communities, 50% of homes lack phone service.
Cost burdens are also common- about one-quarter of Native American households pay 30% or more of household income towards housing costs. The national average is 16%- the current standard in assessing housing affordability is 30% or less. Anything over 30% is considered “cost-burdened”.
The pandemic has worsened things, I’ve had the chance to meet tribal housing staff who tell me about big jumps in applications for emergency rent assistance.
Mortgage lending is near non-existent on Reservations- the most common reasons for being turned down for a mortgage are a lack of credit history, followed by poor credit history. A lack of economic infrastructure is a common factor with few jobs and economic investment in tribal lands.
Overcrowding is common with large multi-generational families living in small quarters. Homelessness on Native American reservations often manifests as overcrowding- many people stay with friends or relatives because they have no place of their own. This makes homelessness on the reservation less conspicuous but no less serious- nearly all tribal housing officials of reservation communities report overcrowding was a problem in their communities.
Approximately 20% of households on Reservation communities are considered overcrowded- the most common definition is more than 1 person per room. Nationally, 3% of households are considered overcrowded across all groups and it correlates strongly with income levels.
Thirty percent of the Native American population is under 18 and children in a household present unique demands on housing needs. As multi-generational households are very common, elderly family members present another set of needs with 49% of Native Americans 65 and older considered physically disabled. I have unfortunately seen quite a few falls in the elderly in their homes that are usually related to housing deficiencies.